Percutaneous renal biopsies: Accuracy,safety, and indications

Fifty-one percutaneous renal needle biopsies were performed on 46 patients. Initial biopsy was adequate for diagnosis in 89% of patients. When a second biopsy was performed, this accuracy increased to 98%. Thirty-four of 51 (67%) biopsies were for renal masses and 17 (33%) for medical indications. Computed tomographic guidance was utilized in 94% of cases. Biopsies of renal masses were performed with 18-21-gauge needles, while biopsies for medical indications were performed with an 18-gauge cutting needle or 14-gauge Trucut. A rate of serious complications of 6% was noted.     

The impact of adhesions on operations and postoperative recovery in colon cancer surgery

Background

Many surgeons assume that adhesions encountered during surgery negatively influence surgical outcomes. This article attempts to assess the role adhesions have on outcomes of colon cancer surgery.

Methods

Records of 1,071 consecutive patients operated for colonic adenocarcinoma (2004–2011) were reviewed. Patients were assigned to 3 groups: no adhesions, any adhesions, or dense adhesions. Multivariate regression assessed the association between adhesions and the duration of surgery and stay as well as laparoscopic conversion and complication rates.

Results

Adhesions were encountered in 329 (30.7%) patients; 138 (12.8%) had dense adhesions. After correction for age and comorbidities, having adhesions was associated with longer surgeries (P < .001), longer hospital stays (P = .029), a borderline significantly higher conversion rate (P = .058), and a delayed return of bowel function (P = .037). Dense adhesions had stronger associations with surgical duration (P < .001), stay duration (P < .001), and conversion (P < .001).

Conclusions

Abdominal adhesions independently put patients at risk for a longer and more complicated perioperative stay after colon cancer surgery.     

Small bowel metastases from renal cell carcinoma: a rare cause of intestinal intussusception

Small bowel metastases from renal cell carcinoma (RCC) are very rare. Clinical presentation includes obstruction, bleeding, intussusception and rarely perforation. We report a case of a 48-year-old female presenting a jejunal intussusception due to intestinal metastasis from RCC. To our knowledge, there are only a few such cases reported in the literature (seven cases). However, if considered in the total summary of reported cases with small bowel metastases from RCC, intussusception is a probable cause.     

Outcomes of persistent lymph node involvement after neoadjuvant therapy for stage III rectal cancer

Introduction

Lymph node involvement is a well-known predictor of recurrent rectal cancer in patient who did not undergo neoadjuvant therapy patients. The role of persistent lymph node disease after neoadjuvant treatment, however, is debatable. This study compares outcomes of patients with clinical, stage III rectal cancer who had nodal disease on surgical pathology after neoadjuvant treatment to patients with negative nodes.

Colorectal Surgery Fellowship Improves In-hospital Mortality After Colectomy and Proctectomy Irrespective of Hospital and Surgeon Volume

Background

General surgery residents are increasingly pursuing sub-specialty training in colorectal (CR) surgery. However, the majority of operations performed by CR surgeons are also performed by general surgeons. This study aimed to assess in-hospital mortality stratified by CR training status after adjusting for surgeon and hospital volume.

Methods

The Statewide Planning and Research Cooperative system database was used to identify all patients who underwent colectomy/proctectomy from January 1, 2000, to December 31, 2014, in the state of New York. Operations performed by board-certified CR surgeons were identified. The relationships between CR board certification and in-hospital mortality, in-hospital complications, length of stay, and ostomy were assessed using multivariate regression models.

Results

Two hundred seventy thousand six hundred eighty-four patients underwent colectomy/proctectomy over the study period. Seventy-two thousand two hundred seventy-nine (26.7%) of operations were performed by CR surgeons. Without adjusting for hospital and surgeon volume, in-hospital mortality was lower for those undergoing colectomy/proctectomy by a CR surgeon (OR 0.49, CI 0.44–0.54, p = 0.001). After controlling for hospital and surgeon volume, the odds of inpatient mortality after colectomy/proctectomy for those operated on by CR surgeons weakened to 0.76 (CI 0.68–0.86, p = 0.001). Hospital and surgeon volume accounted for 53% of the reduction in in-hospital mortality when CR surgeons performed colectomy/proctectomy. Patients who underwent surgery by a CR surgeon had a shorter inpatient stay (0.8 days, p = 0.001) and a decreased chance of colostomy (OR 0.86, CI 0.78–0.95, p < 0.001).

Conclusions

For patients undergoing colectomy/proctectomy, in-hospital mortality decreased when the operation was performed by a CR surgeon even after accounting for hospital and surgeon volume.

     

Prevention of Peritoneal Carcinomatosis from Colon Cancer Cell Seeding Using a Pirarubicin Solution in Rats and Nude Mice

Free malignant cells, which are frequently detected in the washing liquid from the peritoneal cavity before and after resection of human colorectal cancer, are suspected to cause recurrent peritoneal cancer. We carried out an experimental study to compare the prophylactic efficacy of washing the peritoneum with several anticancer drugs and the antiseptic povidone-iodine against the development of peritoneal carcinomatosis from colonic origin in rats and nude mice. The in vitro anticancer activity of a short, 15-minute exposure of pirarubicin, doxorubicin, 5-fluorouracil, cisplatin, mitomycin C, and 1% povidone-iodine was first evaluated by an MTT assay on DHD/K12/PROb rat and LS174T human colon cancer cells. For the in vivo experiments, BDIX rats were inoculated intraperitoneally (IP) with 1 x 10⁶ DHD/K12/PROb cells followed by peritoneal scarring and a colocolic anastomosis. A 15-minute peritoneal washing with the anticancer drugs or povidone-iodine was then performed. Nude mice were IP-inoculated with 1 × 10⁷ LS174T human cells and treated 2 hours later with IP pirarubicin. Only pirarubicin, mitomycin C, and povidone-iodine were fully cytotoxic in vitro against DHD/K12/PROb rat colon cancer cells. In contrast to pirarubicin and povidone-iodine, mitomycin C was not completely active against LS174Tcells. In vivo, pirarubicin cured DHD/K12/PROb-inoculated rats, even at the site of the peritoneal scarring and intestinal anastomosis. IP pirarubicin prevented the development of peritoneal carcinomatosis and liver metastasis in LS174T-inoculated mice. IP washing with pirarubicin cured 2-day-old, but not 7-day-old, peritoneal carcinomatosis in rats. Short exposure to IP pirarubicin is nontoxic and more active than povidone-iodine and other anticancer drugs in preventing the development of peritoneal carcinomatosis from colonic origin in rats and mice. The prophylactic effect of preoperative peritoneal washing with pirarubicin on the development of recurrent peritoneal cancer should be evaluated in a randomized clinical trial.     

Inflammatory inert poly(ethylene glycol)--protein wound dressing improves healing responses in partial- and full-thickness wounds

In this study, a novel soft hydrogel system based on the poly(ethylene glycol)-protein conjugates was evaluated as an occlusive wound dressing material. The hydrogel material, referred by the name of BioAquacare, contains up to 96% of the liquid and is formulated with phosphate-buffered saline and safe preservative to control bacterial load in the open wounds. Performance of the BioAquacare as a wound dressing material was assessed in partial- and full-thickness wounds in pigs. Wound analysis comprised macroscopic determination of the wound size, histological examination of the healing tissues and biochemical characterisation of wound exudates. The wounds treated with BioAquacare healed without any signs of inflammation, skin irritation, oedema or erythema. Cellular composition of the reepithelialised wounds was very similar to that of the normal skin, with a well-developed stratum corneum and epithelial layer. It was observed that BioAquacare plays the role of a liquid compartment, which provides pronounced hydration effect and helps maintain a natural moist environment of the healing tissues. BioAquacare showed relatively low protein-absorbing activity, absorbing predominantly low-molecular-weight molecules, including interleukin (IL)-1beta, IL-6, transforming growth factor-beta1 and products of haemoglobin degradation. It is concluded that application of the moist BioAquacare dressing promotes fast reepithelialisation by creating favourable environment for keratinocytes proliferation and it also reduces scarring. The results show that BioAquacare can be considered as a safe, biocompatible and inflammatory inert wound dressing material.     

Sonographic evaluation of renal stones treated by extracorporeal shock-wave lithotripsy

Real-time sonography was performed on 94 patients the day before and at 24 and 48 hr after extracorporeal shock-wave lithotripsy (ESWL) therapy. The ability of sonography to detect renal stones before ESWL, changes in the calculi after ESWL, and the occurrence of pre- and post-ESWL hydronephrosis was evaluated. Abdominal radiographs and linear renal tomography were used as the standard of comparison. Six other patients had sonography only either before or after ESWL. One hundred patients had a total 105 kidneys treated; 18 kidneys with more than three stones were not included. The other 87 kidneys had 102 stones evaluated by sonography before having ESWL; 66 stones (65%) were identified and 36 were not. Of those calculi not seen, 10 were less than or equal to 5 mm in diameter. Nineteen of the other 26 stones were in the ureter or at the ureteropelvic junction. Comparison of sonograms of 80 kidneys obtained before and after ESWL revealed no change in 37 (46%), more stones or fragments detected in 23 (29%), fewer stones or a change in location in 12 (15%), and an apparent decrease in the size of the original stone in eight (10%). Hydronephrosis was detected by pre-ESWL sonography in 16 kidneys (20%) and was noted to develop after ESWL in 20 (31%) of the 64 other kidneys. These results indicate that the ability of sonography to detect renal calculi is related not only to stone size but also to location. The clinical significance of pre- and post-ESWL hydronephrosis found by sonography must be considered in conjunction with the patient's symptoms, laboratory data, and other radiographic studies. Therefore, the routine use of sonography in the post-ESWL patient does not seem warranted.     

Fungi as emergent etiologic agents in ventilator-associated pneumonia after cardiac surgery

Evaluation of the fungal involvement in the etiology of ventilator-associated pneumonia (VAP) after cardiac surgery. The study had as target the patients diagnosed with VAP after cardiac surgery at the Institute of Cardiovascular Diseases in Ia?i, between April 2nd 2002 and December 31st 2009. MATERIAL AND METHOD: Our study included only cases with fungal etiology of VAP. We examined quantitatively the tracheal aspirates with cytology quality score Q = 2+: microscopy and cultivation. The isolates with clinical significance (= 10(6)UFC/mL significantly associated to inflammatory cells) were identified by standard methods or based on the API system (bioMérieux) and tested by the breakpoints method for susceptibility to antifungal agents. RESULTS: Among the 2167 operated patients, 35 of them were diagnosed with VAP through the clinical pulmonary infection score = 6. Fungi caused 15 of 44 VAP episodes. With a frequency of 30.19%, fungi are on 2nd place within the etiologic agents of VAP after non-fermenting Gram-negative bacilli (45.28%). The fungi involved in VAP were: Candida albicans (16.97%), Pneumocystis jirovecii (3.77%), while Candida glabrata, Candida sake, Candida krusei, Geotrichum capitatum and Cryptococcus humicola, amounted 1.89% each. The widespread use of broad spectrum antibiotics led to the emergence of fungi as a common cause of ventilator-associated pneumonia. The involvement in the VAP etiology of P. jirovecii, an un-cultivable fungus with special sensitivity to antibiotics, requires a careful microscopy of specimens.